Provider Demographics
NPI:1932419231
Name:TAHILIANI, ARUN G (PHD)
Entity type:Individual
Prefix:DR
First Name:ARUN
Middle Name:G
Last Name:TAHILIANI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:ARUNKUMAR
Other - Middle Name:G
Other - Last Name:TAHILIANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2310 FOXHAVEN DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2010
Mailing Address - Country:US
Mailing Address - Phone:904-662-5744
Mailing Address - Fax:
Practice Address - Street 1:2310 FOXHAVEN DR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2010
Practice Address - Country:US
Practice Address - Phone:904-662-5744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist